G04.81 — Other encephalitis and encephalomyelitis
G04.81 is a billable, specific ICD-10-CM code for other encephalitis and encephalomyelitis. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Noninfectious acute disseminated encephalomyelitis (noninfectious ADEM)
Other codes that can never be billed with G04.81
These codes carry an Excludes1 note pointing at G04.81. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading G04.81 alone.
- G04.0Acute disseminated encephalitis and encephalomyelitis (ADEM)
Risk adjustment
G04.81 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
G04.81 is named in 20 Medicare coverage policies — 20 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56380Billing and Coding: Rituximab
- A56551Billing and Coding: Visual Fields Testing
- A56718Billing and Coding: Intravenous Immunoglobulin (IVIG)
- A56771Billing and Coding: Special Electroencephalography
How G04.81 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to G04.81.
- Leukoencephalitis
- Rasmussen encephalitis
- Encephalitis›Rasmussen
- Encephalitis›specified NEC
- Encephalitis›suppurative
- Encephalomyelitis›specified NEC
- Meningoencephalitis›specified organism NEC
- Syndrome›Rasmussen
- Encephalomyelitis›acute disseminated›noninfectious
- Encephalitis›acute›disseminated›noninfectious
Related codes at this level
Codes that share G04.8. If G04.81 is not quite right, the correct code is usually one of these.
Questions about G04.81
- Is G04.81 a billable ICD-10-CM code?
- Yes. G04.81 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does G04.81 sit in the tabular list?
- Diseases of the nervous system (G00-G99), in the block Inflammatory diseases of the central nervous system (G00-G09).